China’s harm reduction programmes implemented since 2003
Between the 1950s and 1980s, China had relatively low levels of drug use. Little attention was put on drugs and HIV prevention by government. However, drug trafficking increasing across the Southern border of China, rapidly increased the supply of drugs in China. Initially China’s centralized government and bureaucratic policy led it to adapt strict policies against drug dealing and compulsory detoxification of drug users. However a new drug policy and an AIDS prevention and control plan started in 1998, and Methadone Maintenance Treatment (MMT) was widely launched from 2003. The latter programme became the key of Chinese success with harm reduction and drug control.
There are few reasons that China began to implement MMT and scale up other complementary harm reduction programmes. Firstly, illicit drug use in China has risen rapidly since late 1980s. The number of registered drug users increased from 70,000 in 1990 to more than 1 million by the end of 2005. Secondly, China has been opening its market to international trade since the 1970s. There is an opener trend in its policy making for harm reductions, which is compatible with the open market strategy. Thirdly, social problems and crimes associating with the drug user were extremely serious between the 1980s and the 1990s. For example, since the first HIV infection was found in a detoxification center in Yunnan Province in 1989, the HIV has been reported that spread around 31 provinces in China by 2002, mainly because of needle sharing to inject heroin. Also, the number of social crime cases related to drug addicting, such as sex commercials, robs and illegal drug dealings, rocketed up and pushed Chinese government to make its final decision of adapting MMT, although MMT could be seen as controversial Traditionally, China’s control over drugs and HIV was through supply reduction and abstinence therapy, which emphases on detoxiﬁcation and rehabilitation programmes. Since 1998, Chinese government set its medium and long term plans for AIDS control and prevention (The Action Plan 2001-2005 calls for creating ‘drug-free communities’ and The Action Plan 2006-2010 promotes harm reduction strategies). China’s harm reduction actions include: condom distribution; treatment and substitution programmes; outreach and peer-education; increasing access to sterile injecting equipment and safe disposal; and voluntary counselling and testing for HIV.
MMT programme has been significantly improved in terms of the scale of MMT clinics since it started to build in 2003. It has opened 708 methadone clinics in 28 provinces and more than 0.3 million drug addicted were treated till 2010. It estimates that MMT has effectively prevented at least 7000 people from HIV/AIDS infection, reduced heroin consumption for 41.8 tons and heroin trading for 25.8 billion RMB. MMT is very effective and successful for helping Chinese government control HIV and drug problems. However, there are still few under-developed aspects of harm reduction programmes. Normally, it closely links to Chinese cultural conscious and social norms. There are two examples.
Overall, the development of MMT expanded very fast during last 7 years, but few areas of China took little regard on HIV and drug abuse problems. It is mainly because Chinese central government over-estimates the importance of the economic growth and links officials’ personal career promotion closely with the local GDP growth or investment attraction. Thus, those provinces viewing economic tagging is more important than any other things will provide less funds and resources (polices, doctors, education and clinic building, etc.) on harm reduction plans.
Moreover, HIV Voluntary Counselling and Testing, known as VCT, is often considered the first step and essential way for HIV education. For instance, while drug users seeking to take HIV/AIDS test, it is easier for medical worker to transcend knowledge about how to protect their sexual and drug using partners and send free condoms to them. It is also better accessible to the information of their health conditions, thus is helpful for further tracking and social help. However, the majority of Chinese people think having HIV is shaming and a lot of people would not go to take the test initiatively; rather, they hide the truth until the situation becomes very bad. A social research shows that ‘23% of health professionals and 45% of pregnant women in China thought HIV was a disease of "low class and illegal" people’. Therefore, there is a potential possibility that people may refuse to accept HIV and drug education even they are provided substantial resources and information.
The needle and syringe exchange programs have been launched in a lot of countries in the world. They aim to offer safe syringe and are normally run by NGOs, hospitals or medical facilities, and local or national governments. Most of Asian countries, however, less efficiently distribute syringe to drug users. As free clean needle is one of the most important ways to reduce HIV transmission through needle sharing injection, it is recommended that distribution rate of 200 needle/syringes per IDU per year is needed. However, China’s needle/syringes distribution is at an average of 32 per IDU although there are about one thousand NSPs in 2010. Further problems refer to unaffordable costs to poor drug users and low level of night access to needle and syringes (China allow syringes legally sold at all pharmacies and medical clinics). Therefore, the improvement should be done in terms of needle/syringes distribution by Chinese government.
NGOs in China take important roles in outreach program performance. NGOs are the more flexible comparing to the central government health system. Thus NGOs can be quickly organized in various sizes and fill in the gaps in health care and social services. Government organized NOGs (GONOGOs), such as Family Planning Associations, Red Cross, Youth League, are more and more stepping into sexually transmitted disease/ AIDS prevention. They also sometimes collaborate with foreign governmental and non-governmental partners to reduce drug use and HIV epidemics.
In sum, Chinese government has reached its main goals of five-year Action plans, and successfully expanded a large number of clinics for drug treatment and MMT provision. However, some areas are relatively short of resources and investment in harm reduction and HIV prevention compared to others. In addition, ‘software’ programs -Chinese people called so-are things like HIV education and information distribution, are not efficient enough as they are profoundly affected by traditional culture and political reasons.